Health Care Servicea

Sample Description

Data Source

Quality of Care

Referenceb

Bronchitis/Asthma

Hospital admissions for bronchitis/asthma are considered appropriate when, for example, a patient has failed to improve with outpatient therapy or has a pneumothorax.

1,038 hospital admissions of children < 18 years old admitted with bronchitis/ asthma.

Same as above.

4.4% of admissions were inappropriate.

Payne et al., 1995

Otitis Media

Use of Tympanostomy Tubes

Indications for tympanostomy tube placement include refractory middle ear infection and chronic mastoiditis.

6,429 children < 16 years old with recurrent acute otitis media and/or persistent otitis media with effusion who were insured in health plans requiring precertification by a utilization review firm.

Interviews with physicians’ office staff at otolaryngology practices from 49 states and the District of Columbia, January 1, 1990, to July 30, 1991; additional interviews were conducted with otolaryngologists to determine the existence of extenuating clinical circumstances.

41% of tube insertions were appropriate, 32% equivocal, and 27% inappropriate. If extenuating clinical circumstances were taken into account, 42% of tube insertions were appropriate, 35% equivocal, and 23% inappropriate.

Kleinman et al., 1994



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